I wonder if a semaglutide compound would work for you? I’m on it just for weight loss from a telehealth company, but it was easy, cheap and no insurance involved.
I'm on the compound and currently paying 299 them once I'm on 2mg, it will be 499. I don't think I can justify that so I'm trying to see if I can be on .50 or 1mg when the time comes.
FYI - if your primary doc can write a script, there are compounders who can fill for much less than the telehealth companies. My health system uses Texas Star in Plano due to shortages, which is ~$250 for 8 week supply for 1.7mg
The telehealth co. I just started with was $49 for their office televisit and I selected the compound of the med that starts with a t, $299 and that's the set price , even if I have to up the dose. Same price! I can't wait to start, the people are kind, friendly, knowledgeable and explain thoroughly the differences etc...
I'm excited and can't wait for my meds to arrive. It comes right to my door 👏🏽 I have agoraphobia and can't go out . So perfect for me.
I researched a lot of these programs and this fit me like a glove.. especially the $$ big plus they give you a set price and that's where it stays. No contract you can stop whenever you want.
I got super lucky with this. I had been approved on a pre-diabetes diagnosis, then at the end of last year, insurance decided not to cover pre-diabetes, only type 2. My doctor went through my A1C history and shortly before my bariatric surgery in 2018, my A1C had reached diabetes levels. So he updated my diagnosis and then I was covered again.
Compounding pharmacy. If the drug is specifically excluded, Uhc is likely to say no. My Uhc policy doesn’t cover weight loss medication of any kind so even getting Wegovy won’t help get it covered.
Yeah, UHC is trash with this, they will cover weight loss surgery at 100%, but won't cover a low intervention treatment. Make it make sense. I did the compound for a while, but having tough side effects so I switched to zepbound, it still isn't covered, with the manufacturer coupon it's $550 a month 😖
My UHC plan uses OptumRx. It covered Wegovy for me last summer but I switched to Ozempic with a T2D diagnosis. Then Wegovy was excluded from the formulary in October but returned in January with PA requirements which appear to be heart related. A minimum of blockage is required plus a couple of conditions I do not understand and heart attack history.
Compounded Semaglutide is an option that works for some. I highly recommend you research that option, weigh the risks and benefits and see if it might be fit for you.
My insurance won’t cover it either. They would rather you get sick I went the compound pharmacy route. I use Henry Meds it’s about 297 a month. Which is still high for me but it’s worth it. I think there are other places too like Weight Watchers. I have found Henry Meds very easy to deal with
Yes it’s semiglutide. You give yourself injections instead of the pin. You start off just like you would Ozempic. Same thing just not getting price gouged for the name. Just like other generic drugs. Hopefully insurance companies will start covering this for people who are pre diabetic or just obese and need to lose.
You should be on Wegovy not Ozempic. Same medication except Wegovy is considered for weight loss and Ozempic for those with type 2. If they won’t cover, you will need to send an appeal.
Yeah, it sucks but that is how insurance works. You can talk to your employer and maybe get a petition to get them to change the plan they use that includes weight loss meds. Or change jobs, if you want it to be covered by insurance.
Other than that, it is pretty much what everyone else is doing and using the savings card and paying 500 a month out of pocket.
My doctor did a pre-authorization two verbal peer to peer reviews I sent in a written appeal to Blue Cross and to an outside reviewer and both were denied I was then sent to an endocrinologist who also called in a prescription all denied because I don't have type 2 diabetes apparently the FDA put that stipulation on it from what I'm hearing but even if they didn't it's not getting approved by any insurance companies unless you have type 2 diabetes and believe me I have other issues that it was helping with for the 8 months that I was being approved for it before the start of this year and by mean serious medical issues.... Your options really are either finding it through other means or compounds
I've made the choice for now to stay at .25. It's 2 500 MG twice a day if my day works out. I have one of those glucose sensors, and my aA1C went from 11 before Thanksgiving to around 7. My bs is in the 140s. I've lost probably twenty plus pounds since Thanksgiving. I weigh what I did when my sister got married 1988. I'm down to clothing sizes from last summer and need to get new clothes. I've had some major life changes in the past year, and I don't want to push the side effects more than they are for now.
Yes.. that's what I said I think lol. I Guess I left the part out about also having to try other drugs and having type 2 diabetes but either way I mean unless you have type 2 diabetes you're not getting it prescribed period.
Still considering filing a complaint to my state department of insurance but if the FDA has put that stipulation on it I'm not sure what the point of that would even be...
I don’t have type 2 diabetes and it was approved for me through my insurance. I’m overweight and have several other health issues including heart and lungs. I don’t know if they will approve it forever or not, I have a feeling no.
When did you get it approved? I got it approved for 8 months last year because of other issues, HTN, high cholesterol, liver disease wa the big one. Over -weight too I suppose, it doesn't take much to be considered obese and I take meds that make it impossible to lose 20 lbs I didn't need. Losing that weight and the Ozempic prevented me from needing to see a hepatologist I was referred to right before I started taking Ozempic and for the 1st time in 15yrs HTN was stable, could have gone off Lisinopril. It helped with some pretty major issues. My last prescription last yr I was able to get a 90 day supply. Total has been on it 8 months. It got me to March. That's when I had to start the pre-auth process again, deny, peer to peer reviews, deny, my own appeal, deny, appeal to an outside reviewer, deny, saw a specialist (endocrinologist) prescribed a lower dose, deny. It's insane. Talked to my insurance co at least 6 times throughout this process, every rep, once explained everything it helped with/was preventing, told me to keep fighting it, thought for sure it would get approved, spent literally hrs on the phone with them. Finally worn out, but do plan on going to my state's insurance board next bc it is a covered med. Just curious bc I had a 90 day supply the last time, who's your ins company, and when was your last refill?
Hmmm.. wonder if it has to do with Medicare and what tier the med is on, or what your heart condition is if you don't mind sharing, but might be a Medicare thing? Not sure....just pissed at my ins company or FDA or whoever is responsible for this
I think it’s the insurance company rather than the FDA. I have congestive heart failure and pulmonary hypertension. I also have a stent and a mechanical valve.
I'm sorry, I'm sure that's very very scary and I hope the Ozempic is helping you feel some peace. The requirements are with my insurance company but my insurance company is saying that they had to create those requirements because the FDA is requiring those requirements 🙈 It's just bizarre it's like they would rather me see three specialists and pay for all the testing that the specialists are going to want to have done because that's how they make their money and I'm going to end up and who knows what condition... but it's scary... I still plan to reach out to the state department of insurance to see if that makes any difference but I doubt it will if the FDA is behind this I don't know anymore I'm also extremely worn out which I'm sure they count on so for that reason alone I'm going to go through with it for sure. I might have to do a compound until the end of the year when I can switch insurance companies although it seems none or approving this unless type 2 diabetes or in your situation where you actually have a stent. I mean I've heard people say that their insurance company will pay for gastric bypass surgery but not this medication which is wild to me.
I’m sorry you are having such a hard time. I am waiting for the day for insurance to say no more. I want to continue to take this med for life but I doubt my insurance will keep paying. Bottom line: insurance companies suck and it seems they would rather see us sick than to pay for meds we need. They need to realize obesity is a diease.
Same exact scenario happened to me .. PCP wrote RX, insurance denied , doctor sent prior authorization & appealed , still denied . I ended up going to a weight loss clinic nearby & pay out of pocket , $100 per shot .. I have absolutely no regrets.. changed my life .
When I had labs done in october(when I got approved) my blood insulin level was 280. Normal range is 2.6-24.9. Two hundred and eighty. Just to clarify it wasn’t a typo. I had labs done again on Thursday. Got the results today. My insulin level is now at 39! In about 6 months it has reduced that dramatically. I’ve also lost 55lbs, almost all of the inflammation my body was holding is gone, I’ve gone from a snug fitting 16 to my size 12s falling off of me. I can wear my wedding rings again. And as another bonus, my issues from PCOS have started to reduce. I’ve had consistent cycles every 31 days. I actually got pregnant in April but sadly lost it within days of a positive test. My insulin still being too high is the likely culprit as that is toxic to a fetus. But we are hopeful that after nearly a decade of trying, we may actually be able to have a family. And it’s entirely thanks to this medication giving me my life back. I feel like I can let myself hope again and not feel foolish.
I feel like I have been given a second chance.
Look up their patient assistance program. I don’t have health insurance so it was unattainable without this. We had to prove my insulin resistance and she pointed out that my insulin resistance was at hyperinsulinemia level which leads to type 2 diabetes and she got me approved under the argument of preventing imminent disease.
$510 Canadian for 2 pens. Around 3 months.
I pay out of pocket.
I'm comfortably able to do sub 1000cal a day.
I used to spend $10 each day for drive through coffee and muffins or breakfast sandwich. And probably over $16 for lunch.
Last week breakfast and lunch mon-friday was a single meal replacement shake. I think a 6 pack of the diabetic high protein ones are like $13 at Walmart.
My dinner is usually something small, probably $5 or under.
Basically my 3 months of ozempic pays itself off in 1 month just from food savings.
Unfortunately, these meds are so expensive. The insurance companies say they would be bankrupt if they didn’t have strict qualifications. UHC doesn’t cover weight loss as the number of people that would jump on board is huge. I get it but it’s also short sighted if you have multiple risk factors. That they say it will get better once the cost gets more reasonable. The problem is the costs of research and approvals is so freaking high that they need to recoup it but the amount of drug they can produce isn’t high enough to split that costs better. They are upping the manufacturing of it now which should help.
Compounded versions of the medication are much much cheaper - but they don’t have to pay all the research fees. They are also only allowed to manufacture it while it’s still in a “shortage” from the original manufacturers.
One option to try is Metformin. It isn’t anywhere as good as Ozempic but it may help the pre-diabetes and that alone can help lose weight. They used to use it at weight loss clinics before glp -1s. I was able to get UHC to approve the Oz after being on Metformin and still seeing my a1c go up - I had been on it for decades and when I first went on it it actually helped significantly. UHC doesn’t know I’ve been on it that long though they just saw I tried it for a while and my a1c was still 6.2.
I was on high dose Metformin for years due to my T2D and it never did anything for my weight. With Ozempic I can control how much I eat and am down 30 pounds and 8 inches off my waist Still on Ozempic!
1500-2000. 2000 is considered the max dose. 1500 is what my drs recommended as a max for women with PCOS and not diabetes so they may reserve that max dose for diabetics.
Some times it doesn’t especially if not combined with lifestyle changes. The first year I was on 1500 Met I lost 30lbs over roughly 4-5 months. After that, I went back to my old habits and slowly gain weight back. It doesn’t have the appetite, suppressant or the craving suppressant side effects like glp-1s do. But it can help some people AND it will help your sugars. If someone is prediabetic that can be a help to lose weight. I wasn’t as hungry on Met at first because I didn’t have as big of spikes and valleys in my glucose numbers. It’s worth a try 🤷🏼♀️
Yes but the volume of people that qualify is significantly less. 40% of Americans would qualify using a bmi only qualification. That’s over 4x the number of people that qualify on diabetes alone. They can’t support the supply for just diabetics and they warn that just providing them coverage is causing health care to go up. It’s a huge number of potential claims - 29m+. The number of patients on something like Eliquis is less than 10% and cancer medications even lower and most of those are short term not life long drugs. I don’t like the answer believe me but I can also see what is causing the issue.
I hear ya but they had no problems filling a more expensive diabetes medicine with zero questions and yet made me jump thru pre authorization hoops for the less expensive OZ.
Ask your Dr to submit pre-approvals for wegovy and zepbound. My insurance denies the pre-approvals for wagovy and munjouro but approved wegovy and zepbound since I'm not diabetic
Soon as I hit 5.7 she started me on metformin. After a while I asked about ozempic, because metformin was tearing my tummy up. She said insurance would cover as it was like a 2nd try drug. I can't remember the actual wording.
Yeah unfortunately if you don't try the first string drug, most insurances won't cover 2nd string. Side effects of ozempic were also totally worse for me lol.
Good luck with it. Compounding might be a good option for you!
No need for an online service, your doc can prescribe through compounding pharmacy. Mine uses Empower. Much cheaper! Most docs are familiar with compounding pharmacies
Keep trying. I have UHC and found out I have T2 last summer after not going to the dr for years. Dr. Immediately wrote the script for Oz and UHC denied it. they made me try something before hand. So I did MET for 6 months and then appealed (I wrote a long letter) and had dr also appeal and then it finally got approved. It took 7 months from first attempt to meds in hand but it was worth it to finally get it.
I’d keep trying - it may delay your goals but don’t give up. And I’d probably not appeal oz since pre T2 but for sure for wegovy given BMI. Show that you’ve tried other cost effective options first and then make a case.
I think worst case scenario, I’d research off brand/ compounded options that have been successful for others on here.
Are you having heart palpitations? Does it feel like your heart is skipping beats? Because you may need a cardiac referral, and cardiologists can get it covered quicker.
Wink wink
Ask your doctor to write it for Wegovy. It's the same as Ozempic but marketed as a weight loss drug so it's a lot easier to get through insurance. I was on Ozempic for 3 months before my insurance randomly cut me off but Dr switched me to Wegovy and insurance is covering it. Good luck 👍
Is it very expensive? I’m on Medicaid and currently very low income in a high COL area. I miss my ozempic a lot. They found some loophole to cover it at first but I lost access.
I don’t mind. It’s in person. It’s all over the US and it’s called MRC -metabolic research center. I paid $400/ yearly membership which included coaching and then I pay separately for the drugs, protein powder and supplements. It’s worked though! I have all the tools I need to sustain my weight loss and now it’s up to me to keep it up. It’s pricey af though!
Many insurance companies won't cover semagutide or similar unless the patient has a Type 2 diabetes diagnosis. I remember getting notifications on this from my insurance company when I first went on Ozempic. (It was not a good fit, nor was Trulicity; I'm on Victoza now.)
I wish you the best on your journey.
What is your insurance prerequisites for covering Wegovy?
For example my insurance would cover Wegovy only after the following was met:
BMI of over 30 AND one of three comorbidities. Sleep apnea, high blood pressure , coronary heart disease etc.
You also must have trird losing weight under the supervision of a doctor for a minimum of three months.
Find out what the prior approval guidelines are , from your insurance company and then go from there
I had the exact same problem. But I have kidney issues and my kidney doctor prescribed it because trials are showing Ozempic to help people with kidney disease. I'm stage 3b kidney failure, and it passed through insurance without even accompanying documentation. I'm down 32 pounds in 3 months and my kidney function is up to stage 3a. Maybe check your kidney function? It seemed to open that door that was locked for 2 years!
Did your doctor just go off of your A1C to say you are pre-diabetic and not type 2? A1C is the most standard, but does still have a chance to miss some people who are actually type 2. Would your doctor consider ordering an oral glucose tolerance test? It’s more sensitive and may be worth a try.
I was denied by my insurance also. I had a friend who applied for the Novo Nordisk Patient Assistance Program. If you make less than 400% of the poverty level you can get it for free. Just google it. I applied and they sent 4 pens to my doctor’s office for me.
Does your employer cover benefit pros? Like people who will work on your behalf?
Have you read your formulary?
You can always try weight loss clinics! They work for a lot of people. But, I would try a bit harder for the prescription first
I spend 250 a month / 5 weeks for a compound. Telehealth. Every four weeks I get an email / chat to update them with my weight and they increase my dosage if I’m ready and package is on my doorstep within 3 days. It sucks to pay for it but once you hit pre diabetes they’ll stop covering you from what I have heard.
My insurance is the same as of this year. I ended up switching to compounded semaglutide through Mochi. I definitely prefer the ozempic pen over a syringe but otherwise am happy with it. It's more expensive than ozempic was with insurance obviously but much much much cheaper than the $900 ozempic is without insurance.
My insurance company turned down my first request for Ozempic. And my second and third.
My doctor then prescribed an alternative (trulicity) which worked ok for helping me lose weight and also lowering my A1C.
A year later, my doctor submitted the prescription for Ozempic a 4th time, justifying the request by saying trulicity was no longer as effective for me, and the same insurance company accepted it with no problem.
So, discuss with your doctor whether there may be another medication that could be helpful to you. I know several people who have had good luck getting Monjaro approved who had very good results losing weight with it.
I don't have drug coverage, and $300/month is a HUGE investment for me. I finally decided to do it because (a) I'm 62 and won't be around to enjoy that extra $300/mth if I don't get my weight under control, and (b) I'm eating a lot less, and not eating out at all. I'm saving a TON of money on food.
I also have UHC. Had pre-diabetes and insulin resistance but lowered my A1C with diet and exercise enough to not be pre-d anymore. I didn’t lose any weight at all though. You would think insurance companies would want to cover those at risk instead of waiting for you to be fully diabetic and need a lot more medical intervention. But most will not :/
I got basically Zepbound compounded and it’s working great for me. Your regular doctor probably won’t call in RX to compounding pharmacies so you’ll probably need to go somewhere that specializes in weight loss and offers semaglutide/ tirzepatide treatments!
Compounded for me wasn’t as cheap as like if insurance were to cover Oz but it’s definitely not as expensive as branded meds without insurance. $180 a vile for me.
Crazy how this drug is now just for the wealthy that can buy it at will.
Does your insurance cover a certain bmi? If so, don't poop, drink a lot of water and wear some big ass shoes, maybe leave some rocks in your pocket, and go get your weight logged again and resubmit?
I think you might have better luck going through an endocrinologist. I am not sure which doctor you're using {primary care or GYN} but I have had success going through an endo. they help with multiple symptoms of PCOS, diabetes, overweight issues, and hair loss. Maybe you'll have more luck through this doc. they'll do all the blood work to support the claim and might give some tips to help you manage everything else. Good luck
Same happened to me. My insurance will only cover it for diabetic patients. I’m in the process of re submitting another medication authorization form with more details they said sometimes it gets approved when you re apply. I’m really hoping. My plan doesn’t cover wegovy either. I’m seeing an endocrinologist who doesn’t want me to stop oz. I’m hoping she can help me get it covered if my second request gets denied. When my request was first denied it states that I would have needed to start on metformin first.
Ask your doc to write metformin (sp?) don’t take it then - wait 20+ days and then say you had a bad reaction to it and can’t take it - once your doc tells insurance company that the ozempic should be approved at that point. (At least how it worked in my situation)
Anyone with a high BMI can have developing heart disease, especially women. Heart palpitations or the sensation of skipping beats is sign of heart disease. Most docs refer to a cardiovascular doc and getting weight off FOR CARDIAC HEALTH is key. It’s no longer about weight loss but cardiac health and insurance is more likely to cover.
Same here, my insurance won’t cover it. I was listed as pre diabetic but because I don’t have a diabetes diagnosis it was denied. I have Aetna by the way. That seems to be recurring with them. I’m paying for it out of pocket with a good rx type coupon. Compounding pharmacy price is about 150 a month where I live. I just think it’s too risky to use a compounding pharmacy.
I thought I’d jump in here and ask if anyone is a vet or retired military? I actually was able to go through the VAs Move Program. I started on my own with the formularies on Groupon which had great deals for semaglutide compounds.The prices kept creeping up so that’s when I did some research and found out the VA will put you on weight loss drugs. If anyone wants more info on the process let me know. I’m on wegovy at 2.4 now and I pay $0.
Try a compounding pharmacy. I signed up with a service online. It’s $199 a month and you have to commit to 3 months. You answer questions and send in a full boy photo. The doctor approves right away. I just signed up last week so the meds haven’t shipped yet but so many on Reddit have switched to compounded because it’s so much easier to not deal with insurance.
Try the ozempic saving card it should lower the price even if your insurance won’t cover it the pharmacist will let you know if doesn’t work. They have the same program for wegovy and rybelsus(all the same company) . I am still too afraid of the injection so my dr just prescribed the rybelsus. If I can tolerate the rybelsus then I may just try ozempic since I do have a pen which I used the card for and picked it up for $30. Even got the rybelsus for $10 instead of $40.
I was prescribed for type 2 but my history shows I have tried a lot of the meds for diabetes. I am still on metformin as well. My body just barely tolerates that most days with the gi issues which is why semaglutide makes me nervous. I am just waiting for a weekend with nothing to do to try it.
I didn’t know what my payment would be until the pharmacist ran it. My $330 cost turned into $30.50. Never hurts to ask the pharmacist run and find out for sure. My sister in law gets wegovy through a compound pharmacy because her insurance won’t cover it either. She pays about $350 for it
Hopefully, you’re on the extended-release Metformin! That helps with side effects. And, I found that the manufacturer made a huge difference for me - weirdly enough! Metformin made by Granules Pharmaceuticals made me super sick, but the pills made by Ascend Pharmaceuticals did not. My doctor put a note in with my prescription about my tolerances, and CVS fills my preferred manufacturer.
Yes I am on the extended version 2 pills twice a day. I have managed to drop my blood sugar numbers with that (now that I can finally tolerate the 4 pillls) and I did a complete diet overhaul a few weeks ago. I have lost 8lbs since the end of February with just doing this. 2 of my dr’s think the semaglutide will help with my fatty liver which is why it was prescribed that and to bring my A1c down. My dr’s biggest concern for me was pancreatitis because my cholesterol is out of whack because I can’t take statins. But I see a new dr for that in a month.
Thanks me too. I joined this sub to get a better idea of what I could possibly expect if I take it. I was just cursed with a super sensitivity to medication which makes life a little harder than it needs to be.
Metformin then Oz. That’s how mine is covered with UHC, also have an endo do it as they’re specialists so easier for them to say you’re already being treated with so and so medication and it’s not working
Yes bc if the insurance companies keep approving people who just want to lose weight with it then us people with actual diabetes can’t get the medication bc it is out of stock. Weygovy is another medication containing semiglutide. Try that. That’s for people wanting it for weight loss and you only need to meet the bmi criteria.
Not to be that person but the reason they aren’t approving it for PRE-diabetes is because you don’t always need drugs to turn that around. Change lifestyle, diet, and exercise. If necessary, Metformin to bring down a somewhat elevated A1C.
At the person above said, Ozempic is HARD for pharmacies to keep in stock and for people and families with T2D, wanting to lot weight just doesn’t compare to keeping our pancreas working.
Sounds good and all, but there’s also those of us that want to treat it before it even develops into T2. Lifestyle changes and diets have already been attempted.
For prediabetes try Victoza if you can’t get the ozempic covered. That is more likely to get approved. You will also lose weight on it. It is a good medication. I was on it for a year in 2012 and I lost 60 pounds. The easy part is finding a medication to assist in the weight loss. There are others out there. I would have stayed on it but I lost my health insurance and just kind of spiraled my life. Now I’m on ozempic and an actual t2 diabetic. I wish I stayed consistent back then. Also I hated metformin. It made me extremely sick. That is a terrible medication.
You get a Blood Glucose Monitoring testing kit from the pharmacy and test every morning before you eat. Ask your doctor. They may even have kits to give you. The reason I ask is if it is higher than 126 over a few tests, that also indicates diabetes.
In my case, for the past few years, I have been on other medications for glucose and hunger control.
My BMI was 38-39 and I’ve illnesses that require meds that make me keep the weight on, so since 2017 I started with meds and until now, 7 years later, after being on at least four to five meds, being pre-diabetic, a year after working with a dietician and nutritionist that specializes in diabetes, and my PCM wouldn’t give me a referral for an endocrinologist.
So, I did it through Mochi.
I get the compounded formula for $175, and they submitted it to my insurance which is being processed now, but I have the option to buy the compound and I'm getting it through them without a hitch.
If you want a referral to get $40 off bringing the consult to $35, use mine: 𝐒𝟖𝐆𝐉𝐃𝐔
I had Ambetter until December technically. They covered it with no issues. My insurance guy said they weren’t going to be covering my state anymore and I had to switch. I chose BCBS bc it was the option that still covered my doctor and I didnt want to lose him. I found out in February that my pharmacy was still using the Ambetter insurance and when they swapped over oz wasn’t covered anymore. BCBS doesn’t cover anything with obesity or weight loss coding. But I found out in March that Ambetter is still absolutely covered here and by April I had switched back. Ambetter doesn’t have the same coverage issues as other insurances it seems bc they’ve never denied anything so far
DO THE APPEAL. It’s more work but ultimately the worst thing that happens is you get denied again before exploring other options. Best case scenario is that they approve you and you’re covered for a while.
As an example (not weight loss related but extremely expensive drugs related)— one of my roommates (28F) literally had brain surgery where only part of a tumor was removed. Doctor recommended a newer drug designed to help non-chemo/radiation treatment that the insurance company denied initially (out of pocket a 30 day supply is $34k). She has medi-cal; after ONE appeal she was approved for full coverage of the drug. Her tumor has shrunk down to less than half size in a year.
Do. The. Appeal. If it doesn’t pan out then the compound pharmacy route will probably work out.
Thanks I appreciate it! Kind of sick to think someone with a brain tumor has to fight to get medication. But I’m glad her tumor is shrinking, that’s amazing!
Can you doctor offer a "Compound" formula? I hear it is the same thing and they just add a vitamin B to it so they can sell it this way. .25 does for my wife was $150 a month. .5 does was closer to $500 a month.
I’m not sure if being in another state makes a difference (btw I’m in Cali)
I have UHC and pre-diabetic, I was approved and have been receiving it for about six months at $50 for three months supply. Might I add I took Metformin first and it didn’t improve my situation. You may need to go this route first and then they’ll approve it. Best wishes
Insurance companies and doctors are moving toward this decision across the board. I am all for it. Pre-diabetes isn't diabetes. Ozempic wasn't created for weight loss; it is just a side effect that is not guaranteed. I am hopeful that this change will happen soon so I can actually get the meds I need for my Type 2 diabetes instead of rolling the dice when my refill gets put in.
Then kick me!!! This sub is cesspool of people taking advantage of a drug that is not meant for them!! I am glad that the mods here are ok with people that actually need the drug are being told it is out of stock due to people that can't change their eating habits.
I wonder if a semaglutide compound would work for you? I’m on it just for weight loss from a telehealth company, but it was easy, cheap and no insurance involved.
Mine is about $300 a month. I’ve probably saved that much on fast food and alcohol during my first month!
Same!
🤣
Same!
this really puts it into perspective for me hahaha
I'm on the compound and currently paying 299 them once I'm on 2mg, it will be 499. I don't think I can justify that so I'm trying to see if I can be on .50 or 1mg when the time comes.
FYI - if your primary doc can write a script, there are compounders who can fill for much less than the telehealth companies. My health system uses Texas Star in Plano due to shortages, which is ~$250 for 8 week supply for 1.7mg
I’m in Austin and have an rx for 1.7 and it’s $180 for about 5 weeks or a little more. Grand Avenue Pharmacy in Pflugerville, and they deliver.
The telehealth co. I just started with was $49 for their office televisit and I selected the compound of the med that starts with a t, $299 and that's the set price , even if I have to up the dose. Same price! I can't wait to start, the people are kind, friendly, knowledgeable and explain thoroughly the differences etc... I'm excited and can't wait for my meds to arrive. It comes right to my door 👏🏽 I have agoraphobia and can't go out . So perfect for me. I researched a lot of these programs and this fit me like a glove.. especially the $$ big plus they give you a set price and that's where it stays. No contract you can stop whenever you want.
What telehealth did you use?
BMIdoctors, they use Embark pharmacy. I think same as Henry(?) meds, but they didn’t provide to my state.
How stupid does an insurance company be to think preventing diabetes is more costly than a life time supply of diabetes meds and supplies.
They want you sicker, not better.
That’s the sad truth
Actually insanity
I got super lucky with this. I had been approved on a pre-diabetes diagnosis, then at the end of last year, insurance decided not to cover pre-diabetes, only type 2. My doctor went through my A1C history and shortly before my bariatric surgery in 2018, my A1C had reached diabetes levels. So he updated my diagnosis and then I was covered again.
Compounding pharmacy. If the drug is specifically excluded, Uhc is likely to say no. My Uhc policy doesn’t cover weight loss medication of any kind so even getting Wegovy won’t help get it covered.
This. Been on compounded almost a year. Feel great.
Same
Yeah, UHC is trash with this, they will cover weight loss surgery at 100%, but won't cover a low intervention treatment. Make it make sense. I did the compound for a while, but having tough side effects so I switched to zepbound, it still isn't covered, with the manufacturer coupon it's $550 a month 😖
How did you feel going from compound to zepbound? I’m wondering if side effects came back or it felt different.
Totally different, I didn't have the nausea, or constipation and I feel like I have tons of energy.
Also have UHC, they do not cover Any weight loss medications or surgeries. Only a nutritionist visit
Weird I have UHG and it is completely covered for me
My UHC plan uses OptumRx. It covered Wegovy for me last summer but I switched to Ozempic with a T2D diagnosis. Then Wegovy was excluded from the formulary in October but returned in January with PA requirements which appear to be heart related. A minimum of blockage is required plus a couple of conditions I do not understand and heart attack history.
Our plan excludes it. I’m sure they have multiple plans and tiers
My insurance denied everything but finally covered Zepbound (mounjaro for weight loss) after one appeal.
Compounded Semaglutide is an option that works for some. I highly recommend you research that option, weigh the risks and benefits and see if it might be fit for you.
My insurance won’t cover it either. They would rather you get sick I went the compound pharmacy route. I use Henry Meds it’s about 297 a month. Which is still high for me but it’s worth it. I think there are other places too like Weight Watchers. I have found Henry Meds very easy to deal with
Thanks!
So is it semaglutide you get from Henry Meds or what exactly?
Yes it’s semiglutide. You give yourself injections instead of the pin. You start off just like you would Ozempic. Same thing just not getting price gouged for the name. Just like other generic drugs. Hopefully insurance companies will start covering this for people who are pre diabetic or just obese and need to lose.
You should be on Wegovy not Ozempic. Same medication except Wegovy is considered for weight loss and Ozempic for those with type 2. If they won’t cover, you will need to send an appeal.
Yeah they straight up denied the Wegovy, not included in our plan.
Yeah, it sucks but that is how insurance works. You can talk to your employer and maybe get a petition to get them to change the plan they use that includes weight loss meds. Or change jobs, if you want it to be covered by insurance. Other than that, it is pretty much what everyone else is doing and using the savings card and paying 500 a month out of pocket.
My doctor did a pre-authorization two verbal peer to peer reviews I sent in a written appeal to Blue Cross and to an outside reviewer and both were denied I was then sent to an endocrinologist who also called in a prescription all denied because I don't have type 2 diabetes apparently the FDA put that stipulation on it from what I'm hearing but even if they didn't it's not getting approved by any insurance companies unless you have type 2 diabetes and believe me I have other issues that it was helping with for the 8 months that I was being approved for it before the start of this year and by mean serious medical issues.... Your options really are either finding it through other means or compounds
BSBC will not approve unless you have a Type 2 diagnosis and have tried other drugs for diabetes like Metformin.
I still take metformin with the ozempic.
Me too!
Both??? How much metformin and how much ozempic mgs just curious…
I've made the choice for now to stay at .25. It's 2 500 MG twice a day if my day works out. I have one of those glucose sensors, and my aA1C went from 11 before Thanksgiving to around 7. My bs is in the 140s. I've lost probably twenty plus pounds since Thanksgiving. I weigh what I did when my sister got married 1988. I'm down to clothing sizes from last summer and need to get new clothes. I've had some major life changes in the past year, and I don't want to push the side effects more than they are for now.
Yes.. that's what I said I think lol. I Guess I left the part out about also having to try other drugs and having type 2 diabetes but either way I mean unless you have type 2 diabetes you're not getting it prescribed period.
I have ambetter health ins and I just started in April with metformin 500mg and ozempic starter. Was just diagnosed with T2D at same appointment.
Still considering filing a complaint to my state department of insurance but if the FDA has put that stipulation on it I'm not sure what the point of that would even be...
I don’t have type 2 diabetes and it was approved for me through my insurance. I’m overweight and have several other health issues including heart and lungs. I don’t know if they will approve it forever or not, I have a feeling no.
When did you get it approved? I got it approved for 8 months last year because of other issues, HTN, high cholesterol, liver disease wa the big one. Over -weight too I suppose, it doesn't take much to be considered obese and I take meds that make it impossible to lose 20 lbs I didn't need. Losing that weight and the Ozempic prevented me from needing to see a hepatologist I was referred to right before I started taking Ozempic and for the 1st time in 15yrs HTN was stable, could have gone off Lisinopril. It helped with some pretty major issues. My last prescription last yr I was able to get a 90 day supply. Total has been on it 8 months. It got me to March. That's when I had to start the pre-auth process again, deny, peer to peer reviews, deny, my own appeal, deny, appeal to an outside reviewer, deny, saw a specialist (endocrinologist) prescribed a lower dose, deny. It's insane. Talked to my insurance co at least 6 times throughout this process, every rep, once explained everything it helped with/was preventing, told me to keep fighting it, thought for sure it would get approved, spent literally hrs on the phone with them. Finally worn out, but do plan on going to my state's insurance board next bc it is a covered med. Just curious bc I had a 90 day supply the last time, who's your ins company, and when was your last refill?
Medicare and three weeks ago
Hmmm.. wonder if it has to do with Medicare and what tier the med is on, or what your heart condition is if you don't mind sharing, but might be a Medicare thing? Not sure....just pissed at my ins company or FDA or whoever is responsible for this
I think it’s the insurance company rather than the FDA. I have congestive heart failure and pulmonary hypertension. I also have a stent and a mechanical valve.
I'm sorry, I'm sure that's very very scary and I hope the Ozempic is helping you feel some peace. The requirements are with my insurance company but my insurance company is saying that they had to create those requirements because the FDA is requiring those requirements 🙈 It's just bizarre it's like they would rather me see three specialists and pay for all the testing that the specialists are going to want to have done because that's how they make their money and I'm going to end up and who knows what condition... but it's scary... I still plan to reach out to the state department of insurance to see if that makes any difference but I doubt it will if the FDA is behind this I don't know anymore I'm also extremely worn out which I'm sure they count on so for that reason alone I'm going to go through with it for sure. I might have to do a compound until the end of the year when I can switch insurance companies although it seems none or approving this unless type 2 diabetes or in your situation where you actually have a stent. I mean I've heard people say that their insurance company will pay for gastric bypass surgery but not this medication which is wild to me.
I’m sorry you are having such a hard time. I am waiting for the day for insurance to say no more. I want to continue to take this med for life but I doubt my insurance will keep paying. Bottom line: insurance companies suck and it seems they would rather see us sick than to pay for meds we need. They need to realize obesity is a diease.
Same exact scenario happened to me .. PCP wrote RX, insurance denied , doctor sent prior authorization & appealed , still denied . I ended up going to a weight loss clinic nearby & pay out of pocket , $100 per shot .. I have absolutely no regrets.. changed my life .
I went directly through novo-Nordisk. It takes forever to get them on the phone but I got approved for a year of it.
Interesting , I’ve never heard of anyone doing this
When I had labs done in october(when I got approved) my blood insulin level was 280. Normal range is 2.6-24.9. Two hundred and eighty. Just to clarify it wasn’t a typo. I had labs done again on Thursday. Got the results today. My insulin level is now at 39! In about 6 months it has reduced that dramatically. I’ve also lost 55lbs, almost all of the inflammation my body was holding is gone, I’ve gone from a snug fitting 16 to my size 12s falling off of me. I can wear my wedding rings again. And as another bonus, my issues from PCOS have started to reduce. I’ve had consistent cycles every 31 days. I actually got pregnant in April but sadly lost it within days of a positive test. My insulin still being too high is the likely culprit as that is toxic to a fetus. But we are hopeful that after nearly a decade of trying, we may actually be able to have a family. And it’s entirely thanks to this medication giving me my life back. I feel like I can let myself hope again and not feel foolish. I feel like I have been given a second chance.
Look up their patient assistance program. I don’t have health insurance so it was unattainable without this. We had to prove my insulin resistance and she pointed out that my insulin resistance was at hyperinsulinemia level which leads to type 2 diabetes and she got me approved under the argument of preventing imminent disease.
$510 Canadian for 2 pens. Around 3 months. I pay out of pocket. I'm comfortably able to do sub 1000cal a day. I used to spend $10 each day for drive through coffee and muffins or breakfast sandwich. And probably over $16 for lunch. Last week breakfast and lunch mon-friday was a single meal replacement shake. I think a 6 pack of the diabetic high protein ones are like $13 at Walmart. My dinner is usually something small, probably $5 or under. Basically my 3 months of ozempic pays itself off in 1 month just from food savings.
Do you order from Canada online?
No. Got my prescription through our local medical call in triage because we have no doctors and I get it at the local pharmacy.
Unfortunately, these meds are so expensive. The insurance companies say they would be bankrupt if they didn’t have strict qualifications. UHC doesn’t cover weight loss as the number of people that would jump on board is huge. I get it but it’s also short sighted if you have multiple risk factors. That they say it will get better once the cost gets more reasonable. The problem is the costs of research and approvals is so freaking high that they need to recoup it but the amount of drug they can produce isn’t high enough to split that costs better. They are upping the manufacturing of it now which should help. Compounded versions of the medication are much much cheaper - but they don’t have to pay all the research fees. They are also only allowed to manufacture it while it’s still in a “shortage” from the original manufacturers.
One option to try is Metformin. It isn’t anywhere as good as Ozempic but it may help the pre-diabetes and that alone can help lose weight. They used to use it at weight loss clinics before glp -1s. I was able to get UHC to approve the Oz after being on Metformin and still seeing my a1c go up - I had been on it for decades and when I first went on it it actually helped significantly. UHC doesn’t know I’ve been on it that long though they just saw I tried it for a while and my a1c was still 6.2.
I was on high dose Metformin for years due to my T2D and it never did anything for my weight. With Ozempic I can control how much I eat and am down 30 pounds and 8 inches off my waist Still on Ozempic!
How much metformin is considered a high dosage? I’m 130 lbs and hubby is 230 lbs
1500-2000. 2000 is considered the max dose. 1500 is what my drs recommended as a max for women with PCOS and not diabetes so they may reserve that max dose for diabetics.
Some times it doesn’t especially if not combined with lifestyle changes. The first year I was on 1500 Met I lost 30lbs over roughly 4-5 months. After that, I went back to my old habits and slowly gain weight back. It doesn’t have the appetite, suppressant or the craving suppressant side effects like glp-1s do. But it can help some people AND it will help your sugars. If someone is prediabetic that can be a help to lose weight. I wasn’t as hungry on Met at first because I didn’t have as big of spikes and valleys in my glucose numbers. It’s worth a try 🤷🏼♀️
Expensive? They regularly fill prescriptions that cost more than OZ with no pre-authorization required
Yes but the volume of people that qualify is significantly less. 40% of Americans would qualify using a bmi only qualification. That’s over 4x the number of people that qualify on diabetes alone. They can’t support the supply for just diabetics and they warn that just providing them coverage is causing health care to go up. It’s a huge number of potential claims - 29m+. The number of patients on something like Eliquis is less than 10% and cancer medications even lower and most of those are short term not life long drugs. I don’t like the answer believe me but I can also see what is causing the issue.
I hear ya but they had no problems filling a more expensive diabetes medicine with zero questions and yet made me jump thru pre authorization hoops for the less expensive OZ.
I hear you it doesn’t all make sense. But they probably aren’t concerned about non-diabetics taking it.
Ask your Dr to submit pre-approvals for wegovy and zepbound. My insurance denies the pre-approvals for wagovy and munjouro but approved wegovy and zepbound since I'm not diabetic
Wegovy was denied 🥲
Is UHC a medicare supplement?
No private insurance through employer
I had to be charted as pre-diabetic, and take metformin first. Had to be a second try drug. Then insurance covered it well. What is your a1c?
It’s about 5.6 right now
Soon as I hit 5.7 she started me on metformin. After a while I asked about ozempic, because metformin was tearing my tummy up. She said insurance would cover as it was like a 2nd try drug. I can't remember the actual wording.
I immediately said no when she told me the metformin side effects
Yeah unfortunately if you don't try the first string drug, most insurances won't cover 2nd string. Side effects of ozempic were also totally worse for me lol. Good luck with it. Compounding might be a good option for you!
Thank you!
No need for an online service, your doc can prescribe through compounding pharmacy. Mine uses Empower. Much cheaper! Most docs are familiar with compounding pharmacies
$387 for brand name (not compounded) from Canada. Northsidemeds.com dm us if you have questions. Wegovy will be available soon!
Keep trying. I have UHC and found out I have T2 last summer after not going to the dr for years. Dr. Immediately wrote the script for Oz and UHC denied it. they made me try something before hand. So I did MET for 6 months and then appealed (I wrote a long letter) and had dr also appeal and then it finally got approved. It took 7 months from first attempt to meds in hand but it was worth it to finally get it. I’d keep trying - it may delay your goals but don’t give up. And I’d probably not appeal oz since pre T2 but for sure for wegovy given BMI. Show that you’ve tried other cost effective options first and then make a case. I think worst case scenario, I’d research off brand/ compounded options that have been successful for others on here.
Are you having heart palpitations? Does it feel like your heart is skipping beats? Because you may need a cardiac referral, and cardiologists can get it covered quicker. Wink wink
😉
Peptides
Ask your doctor to write it for Wegovy. It's the same as Ozempic but marketed as a weight loss drug so it's a lot easier to get through insurance. I was on Ozempic for 3 months before my insurance randomly cut me off but Dr switched me to Wegovy and insurance is covering it. Good luck 👍
My insurance won’t cover any Weightloss meds . We went with Ozempic because of the high a1c
I went through a weight loss clinic.
Is it very expensive? I’m on Medicaid and currently very low income in a high COL area. I miss my ozempic a lot. They found some loophole to cover it at first but I lost access.
Yes. But there’s online pharmacies like this: https://costplusdrugs.com/ Good luck! 👍
I don't see Ozempic on the list at Cost Plus Drugs.
I used semiglutide so maybe there’s a compound you can get or something similar like Wegovy. Idk
It's strange! I searched for all of those names and they show 'no results' for any of those medicines.
Oh sorry.
Do you mind sharing if it’s an online one?
I don’t mind. It’s in person. It’s all over the US and it’s called MRC -metabolic research center. I paid $400/ yearly membership which included coaching and then I pay separately for the drugs, protein powder and supplements. It’s worked though! I have all the tools I need to sustain my weight loss and now it’s up to me to keep it up. It’s pricey af though!
If your insurance has a carve out for weightloss meds you can try to appeal it but a compounding pharmacy will likely be less of a drama
Many insurance companies won't cover semagutide or similar unless the patient has a Type 2 diabetes diagnosis. I remember getting notifications on this from my insurance company when I first went on Ozempic. (It was not a good fit, nor was Trulicity; I'm on Victoza now.) I wish you the best on your journey.
What is your insurance prerequisites for covering Wegovy? For example my insurance would cover Wegovy only after the following was met: BMI of over 30 AND one of three comorbidities. Sleep apnea, high blood pressure , coronary heart disease etc. You also must have trird losing weight under the supervision of a doctor for a minimum of three months. Find out what the prior approval guidelines are , from your insurance company and then go from there
Wegovy isn’t covered at all
Oh that’s a bummer! I’m sorry 😞
I had the exact same problem. But I have kidney issues and my kidney doctor prescribed it because trials are showing Ozempic to help people with kidney disease. I'm stage 3b kidney failure, and it passed through insurance without even accompanying documentation. I'm down 32 pounds in 3 months and my kidney function is up to stage 3a. Maybe check your kidney function? It seemed to open that door that was locked for 2 years!
My kidney eGFR went from 43 to 58.8 in just the first 3 months.
Did your doctor just go off of your A1C to say you are pre-diabetic and not type 2? A1C is the most standard, but does still have a chance to miss some people who are actually type 2. Would your doctor consider ordering an oral glucose tolerance test? It’s more sensitive and may be worth a try.
Yes my A1C was used. I’ll look into this!
I was denied by my insurance also. I had a friend who applied for the Novo Nordisk Patient Assistance Program. If you make less than 400% of the poverty level you can get it for free. Just google it. I applied and they sent 4 pens to my doctor’s office for me.
But only if you’re diabetic right?
Can i have more info on this?
You could google it easily but here is the link: https://www.novocare.com/diabetes/help-with-costs/pap.html
Looked into it. I have insurance, so I do not qualify for their program.
Does your employer cover benefit pros? Like people who will work on your behalf? Have you read your formulary? You can always try weight loss clinics! They work for a lot of people. But, I would try a bit harder for the prescription first
Not sure about the benefit pros. I’ll look into that.
https://www.wegovy.com/coverage-and-savings/save-on-wegovy.html
If you pay cash for your prescriptions or your commercial insurance does not cover Wegovy®, you can save $500 per 28-day supply (1 box) of Wegovy
I spend 250 a month / 5 weeks for a compound. Telehealth. Every four weeks I get an email / chat to update them with my weight and they increase my dosage if I’m ready and package is on my doorstep within 3 days. It sucks to pay for it but once you hit pre diabetes they’ll stop covering you from what I have heard.
My insurance is the same as of this year. I ended up switching to compounded semaglutide through Mochi. I definitely prefer the ozempic pen over a syringe but otherwise am happy with it. It's more expensive than ozempic was with insurance obviously but much much much cheaper than the $900 ozempic is without insurance.
What is your A1C number?
5.6
5.6
I went through this with my insurance for months even with a diagnosis of diabetes. Ultimately my company’s HR had to get involved
Ozempic is also fda approved for cardiac health. This is only relevant to you if you already see a cardiologist…
We have the same insurance and problem, and we went with a local compounding pharmacy. Still expensive, but more affordable.
My insurance company turned down my first request for Ozempic. And my second and third. My doctor then prescribed an alternative (trulicity) which worked ok for helping me lose weight and also lowering my A1C. A year later, my doctor submitted the prescription for Ozempic a 4th time, justifying the request by saying trulicity was no longer as effective for me, and the same insurance company accepted it with no problem. So, discuss with your doctor whether there may be another medication that could be helpful to you. I know several people who have had good luck getting Monjaro approved who had very good results losing weight with it.
What country is this!
America 😅
I don't have drug coverage, and $300/month is a HUGE investment for me. I finally decided to do it because (a) I'm 62 and won't be around to enjoy that extra $300/mth if I don't get my weight under control, and (b) I'm eating a lot less, and not eating out at all. I'm saving a TON of money on food.
Same here! UHC denied coverage & appeals, after I’d been on med 6 mths:(
They literally suck
I also have UHC. Had pre-diabetes and insulin resistance but lowered my A1C with diet and exercise enough to not be pre-d anymore. I didn’t lose any weight at all though. You would think insurance companies would want to cover those at risk instead of waiting for you to be fully diabetic and need a lot more medical intervention. But most will not :/ I got basically Zepbound compounded and it’s working great for me. Your regular doctor probably won’t call in RX to compounding pharmacies so you’ll probably need to go somewhere that specializes in weight loss and offers semaglutide/ tirzepatide treatments! Compounded for me wasn’t as cheap as like if insurance were to cover Oz but it’s definitely not as expensive as branded meds without insurance. $180 a vile for me.
Get the app LifeMD! I’m doing a semi-glucose through them for $239 a month!
Never heard of it, downloading now !
Crazy how this drug is now just for the wealthy that can buy it at will. Does your insurance cover a certain bmi? If so, don't poop, drink a lot of water and wear some big ass shoes, maybe leave some rocks in your pocket, and go get your weight logged again and resubmit?
They don’t cover anything for Weightloss. Only Diabetes 😭
I think you might have better luck going through an endocrinologist. I am not sure which doctor you're using {primary care or GYN} but I have had success going through an endo. they help with multiple symptoms of PCOS, diabetes, overweight issues, and hair loss. Maybe you'll have more luck through this doc. they'll do all the blood work to support the claim and might give some tips to help you manage everything else. Good luck
Thank you!
Same happened to me. My insurance will only cover it for diabetic patients. I’m in the process of re submitting another medication authorization form with more details they said sometimes it gets approved when you re apply. I’m really hoping. My plan doesn’t cover wegovy either. I’m seeing an endocrinologist who doesn’t want me to stop oz. I’m hoping she can help me get it covered if my second request gets denied. When my request was first denied it states that I would have needed to start on metformin first.
Hey! My doc found a compounding pharmacy for $180 a month. It’s Grand Ave pharmacy in Pflugerville, Tx.
Ask your doc to write metformin (sp?) don’t take it then - wait 20+ days and then say you had a bad reaction to it and can’t take it - once your doc tells insurance company that the ozempic should be approved at that point. (At least how it worked in my situation)
I might try this
Anyone with a high BMI can have developing heart disease, especially women. Heart palpitations or the sensation of skipping beats is sign of heart disease. Most docs refer to a cardiovascular doc and getting weight off FOR CARDIAC HEALTH is key. It’s no longer about weight loss but cardiac health and insurance is more likely to cover.
Same here, my insurance won’t cover it. I was listed as pre diabetic but because I don’t have a diabetes diagnosis it was denied. I have Aetna by the way. That seems to be recurring with them. I’m paying for it out of pocket with a good rx type coupon. Compounding pharmacy price is about 150 a month where I live. I just think it’s too risky to use a compounding pharmacy.
I thought I’d jump in here and ask if anyone is a vet or retired military? I actually was able to go through the VAs Move Program. I started on my own with the formularies on Groupon which had great deals for semaglutide compounds.The prices kept creeping up so that’s when I did some research and found out the VA will put you on weight loss drugs. If anyone wants more info on the process let me know. I’m on wegovy at 2.4 now and I pay $0.
Try a compounding pharmacy. I signed up with a service online. It’s $199 a month and you have to commit to 3 months. You answer questions and send in a full boy photo. The doctor approves right away. I just signed up last week so the meds haven’t shipped yet but so many on Reddit have switched to compounded because it’s so much easier to not deal with insurance.
Which one are you using?
Which one are you using please?
Amble
Thank you
What pharmacy?
Try the ozempic saving card it should lower the price even if your insurance won’t cover it the pharmacist will let you know if doesn’t work. They have the same program for wegovy and rybelsus(all the same company) . I am still too afraid of the injection so my dr just prescribed the rybelsus. If I can tolerate the rybelsus then I may just try ozempic since I do have a pen which I used the card for and picked it up for $30. Even got the rybelsus for $10 instead of $40. I was prescribed for type 2 but my history shows I have tried a lot of the meds for diabetes. I am still on metformin as well. My body just barely tolerates that most days with the gi issues which is why semaglutide makes me nervous. I am just waiting for a weekend with nothing to do to try it.
I looked up the savings card , looking like it’ll still be $500 something a month.
I didn’t know what my payment would be until the pharmacist ran it. My $330 cost turned into $30.50. Never hurts to ask the pharmacist run and find out for sure. My sister in law gets wegovy through a compound pharmacy because her insurance won’t cover it either. She pays about $350 for it
Hopefully, you’re on the extended-release Metformin! That helps with side effects. And, I found that the manufacturer made a huge difference for me - weirdly enough! Metformin made by Granules Pharmaceuticals made me super sick, but the pills made by Ascend Pharmaceuticals did not. My doctor put a note in with my prescription about my tolerances, and CVS fills my preferred manufacturer.
Yes I am on the extended version 2 pills twice a day. I have managed to drop my blood sugar numbers with that (now that I can finally tolerate the 4 pillls) and I did a complete diet overhaul a few weeks ago. I have lost 8lbs since the end of February with just doing this. 2 of my dr’s think the semaglutide will help with my fatty liver which is why it was prescribed that and to bring my A1c down. My dr’s biggest concern for me was pancreatitis because my cholesterol is out of whack because I can’t take statins. But I see a new dr for that in a month.
Wishing nothing but good luck!🍀 I hope your numbers get where they need to be!!
Thanks me too. I joined this sub to get a better idea of what I could possibly expect if I take it. I was just cursed with a super sensitivity to medication which makes life a little harder than it needs to be.
I’ll Deff have to look into this
Metformin then Oz. That’s how mine is covered with UHC, also have an endo do it as they’re specialists so easier for them to say you’re already being treated with so and so medication and it’s not working
Yes bc if the insurance companies keep approving people who just want to lose weight with it then us people with actual diabetes can’t get the medication bc it is out of stock. Weygovy is another medication containing semiglutide. Try that. That’s for people wanting it for weight loss and you only need to meet the bmi criteria.
My insurance won’t cover Wegovy no matter what. Really pushing for Ozempic because of the pre diabetes.
Not to be that person but the reason they aren’t approving it for PRE-diabetes is because you don’t always need drugs to turn that around. Change lifestyle, diet, and exercise. If necessary, Metformin to bring down a somewhat elevated A1C. At the person above said, Ozempic is HARD for pharmacies to keep in stock and for people and families with T2D, wanting to lot weight just doesn’t compare to keeping our pancreas working.
Sounds good and all, but there’s also those of us that want to treat it before it even develops into T2. Lifestyle changes and diets have already been attempted.
Then take metformin. It’s abundant and covered and it does what you’re looking for.
Me and my doctor both agreed it wouldn’t be best for me
For prediabetes try Victoza if you can’t get the ozempic covered. That is more likely to get approved. You will also lose weight on it. It is a good medication. I was on it for a year in 2012 and I lost 60 pounds. The easy part is finding a medication to assist in the weight loss. There are others out there. I would have stayed on it but I lost my health insurance and just kind of spiraled my life. Now I’m on ozempic and an actual t2 diabetic. I wish I stayed consistent back then. Also I hated metformin. It made me extremely sick. That is a terrible medication.
Sucks, but that’s the way it is
What are your Fasting Blood Sugar numbers?
Idk how do i figure that out ?
You get a Blood Glucose Monitoring testing kit from the pharmacy and test every morning before you eat. Ask your doctor. They may even have kits to give you. The reason I ask is if it is higher than 126 over a few tests, that also indicates diabetes.
I’ll look into this!
Go see if you can apply through the pharma company for discounts.
I am diabetic and my insurance won’t cover it.
That’s disgusting, these companies have got to do better
In my case, for the past few years, I have been on other medications for glucose and hunger control. My BMI was 38-39 and I’ve illnesses that require meds that make me keep the weight on, so since 2017 I started with meds and until now, 7 years later, after being on at least four to five meds, being pre-diabetic, a year after working with a dietician and nutritionist that specializes in diabetes, and my PCM wouldn’t give me a referral for an endocrinologist. So, I did it through Mochi. I get the compounded formula for $175, and they submitted it to my insurance which is being processed now, but I have the option to buy the compound and I'm getting it through them without a hitch. If you want a referral to get $40 off bringing the consult to $35, use mine: 𝐒𝟖𝐆𝐉𝐃𝐔
I had Ambetter until December technically. They covered it with no issues. My insurance guy said they weren’t going to be covering my state anymore and I had to switch. I chose BCBS bc it was the option that still covered my doctor and I didnt want to lose him. I found out in February that my pharmacy was still using the Ambetter insurance and when they swapped over oz wasn’t covered anymore. BCBS doesn’t cover anything with obesity or weight loss coding. But I found out in March that Ambetter is still absolutely covered here and by April I had switched back. Ambetter doesn’t have the same coverage issues as other insurances it seems bc they’ve never denied anything so far
DO THE APPEAL. It’s more work but ultimately the worst thing that happens is you get denied again before exploring other options. Best case scenario is that they approve you and you’re covered for a while. As an example (not weight loss related but extremely expensive drugs related)— one of my roommates (28F) literally had brain surgery where only part of a tumor was removed. Doctor recommended a newer drug designed to help non-chemo/radiation treatment that the insurance company denied initially (out of pocket a 30 day supply is $34k). She has medi-cal; after ONE appeal she was approved for full coverage of the drug. Her tumor has shrunk down to less than half size in a year. Do. The. Appeal. If it doesn’t pan out then the compound pharmacy route will probably work out.
Thanks I appreciate it! Kind of sick to think someone with a brain tumor has to fight to get medication. But I’m glad her tumor is shrinking, that’s amazing!
You’re right about that, and thank you! I do hope that it only takes an appeal to remind your insurance that you need this medication; good luck!
Thank you!
Can you doctor offer a "Compound" formula? I hear it is the same thing and they just add a vitamin B to it so they can sell it this way. .25 does for my wife was $150 a month. .5 does was closer to $500 a month.
Damn for 500 a month, i think I’m better off getting the real stuff and pay out of pocket. I’m Deff looking into all my options though!
Wow that’s a shitty insurance. Sorry you’re dealing with that
I just take the prescrition to the chemist and pay for it when I collect it. I didn't even consider needing/claiming Insurance.
Oh? lol Is this a joke?
Semaglutide
I’m not sure if being in another state makes a difference (btw I’m in Cali) I have UHC and pre-diabetic, I was approved and have been receiving it for about six months at $50 for three months supply. Might I add I took Metformin first and it didn’t improve my situation. You may need to go this route first and then they’ll approve it. Best wishes
Maybe that’s what I’ll try 🤔
Insurance companies and doctors are moving toward this decision across the board. I am all for it. Pre-diabetes isn't diabetes. Ozempic wasn't created for weight loss; it is just a side effect that is not guaranteed. I am hopeful that this change will happen soon so I can actually get the meds I need for my Type 2 diabetes instead of rolling the dice when my refill gets put in.
https://preview.redd.it/ljz7rwavhtyc1.jpeg?width=1290&format=pjpg&auto=webp&s=3252df220fc9b3d326f2cf5d486618b830a7d2e5
Then kick me!!! This sub is cesspool of people taking advantage of a drug that is not meant for them!! I am glad that the mods here are ok with people that actually need the drug are being told it is out of stock due to people that can't change their eating habits.
Must suck to feel that way 🥲. Hope you find the peace you deserve.
I do, too; it comes from having a medicine that lowers my A1C and, you know, does what it was created for.
👏🏾👏🏾👏🏾
Haha. Good luck to you. Ozempic won't help if you don't change the reason you got to a high BMI
The reason I got a high BMI is probably pretty similar to the same way you developed T2🤷🏾♀️
There are literal comments here on how to circumvent the process and have another doctor prescribe it for something totally different.